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Ajayi SU, Arora P. A Survey Study on Clinicians' Rationale and Attitude Towards the Prescription of Antipsychotic Polypharmacy in the East Perth Metropolitan Area in Western Australia. Cureus 2023; 15:e37234. [PMID: 37064723 PMCID: PMC10098027 DOI: 10.7759/cureus.37234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 04/18/2023] Open
Abstract
Objective Patients challenging refractory and residual psychotic symptoms have led to the concomitant use of combined antipsychotics, which was later introduced and labelled 'antipsychotic polypharmacy' (APP). Many clinicians have become somewhat hesitant to adjust psychotropic medication dosages, resulting in a higher dose and combination prescription of antipsychotics and only achieving modest success. This study examines and investigates clinician perspectives and the rationale for the prescription of antipsychotic polypharmacy. Methods A structured questionnaire designed to reflect 15 target-directed questions evaluating clinicians' attitudes and rationale on antipsychotic polypharmacy prescription was administered from November to December 2022. Information was obtained from inpatient and outpatient prescribers (psychiatric consultants) in two government-funded psychiatric facilities and outpatient clinics in the East Perth Metropolitan Area in Western Australia. Results After exclusion, a total of 45 participants' responses were analysed. These results suggest a higher frequency of questions relating to the prescription of APP based on previous prescribers' consultation and recommendation from a prior treating team; senior nurses' pressure impacting clinicians' decisions on APP perception; and the patient's risk of aggression impacting the clinician's rationale for the prescription of APP. Conclusions Clinicians' rationale and attitude towards the prescription of APP are mostly influenced by recommendations from prior treatment teams or consultations and patients' risk for aggression without compromising practice guidelines. Our findings also highlight the need to evaluate prescribers' attitudes and how it presents an opportunity to enhance patients' holistic outcomes.
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Affiliation(s)
| | - Praveena Arora
- Older Adult Mental Health Service, Royal Perth Bentley Health Service, Perth, AUS
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Chatterjee K, Dangi A, Sharma R, Yadav P, Chauhan VS, Prakash J. Adding pre-emptive anticholinergics to antipsychotics: Is it justified? Ind Psychiatry J 2022; 31:370-373. [PMID: 36419690 PMCID: PMC9678160 DOI: 10.4103/ipj.ipj_269_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 06/07/2022] [Accepted: 06/18/2022] [Indexed: 11/04/2022] Open
Abstract
Anti-psychotics are the mainstay of treatment for Schizophrenia and psychotic disorders. Historically, anticholinergics have been prescribed to prevent or treat extrapyramidal side effects (EPS) associated with first-generation antipsychotics (FGAs). Even though newer antipsychotics are associated with markedly lower rates of EPS, concurrent anticholinergic use remains high. Use of these medications has potential for long-term side effects, worsening of EPS and poor adherence. We have briefly discussed the limited association between second-generation antipsychotics (SGAs) and EPS, the efficacy of anticholinergics for different types of EPS, and summarized various national and international guidelines on the subject. In conclusion, there is no evidence for prophylactic use of anticholinergics with antipsychotics. Clinicians need to guard against this tendency to be unduly cautious.
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Affiliation(s)
- Kaushik Chatterjee
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ankit Dangi
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Rachit Sharma
- Department of Psychiatry, Base Hospital, Tezpur, Assam, India
| | - Prateek Yadav
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Vinay Singh Chauhan
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
| | - Jyoti Prakash
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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Anozie IG, James BO, Omoaregba JO, Oriji SO, Erohubie PO, Enebe AC. Correlates of high-dose antipsychotic prescription amongst outpatients with Schizophrenia in a Nigerian Hospital. S Afr J Psychiatr 2022; 28:1791. [PMID: 35547105 PMCID: PMC9082254 DOI: 10.4102/sajpsychiatry.v28i0.1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Treatment guidelines recommend the use of antipsychotic monotherapy at effective doses for the treatment of schizophrenia, although about a third of the sufferers still receive high-dose antipsychotic treatment. Current evidence suggests that high-dose antipsychotic prescription (HDAP) not only fails to improve outcomes but also increases side effects. Aim Our study aimed to determine the prevalence of HDAP and its association with illness severity, medication adherence behaviour and side effects amongst outpatients with schizophrenia. Setting The Federal Neuro-Psychiatric Hospital, Benin-City, Nigeria. Methods A cross-sectional study of 320 attendees with schizophrenia at the outpatient department was undertaken. We administered a sociodemographic and antipsychotic medication questionnaire, Mini-International Neuropsychiatric Interview, Positive and Negative Syndrome Scale, Liverpool University Neuroleptic Side Effects Rating Scales and Medication Adherence Rating Scales. High-dose antipsychotic prescription was determined by the ratio of prescribed daily dose to defined daily dose greater than 1.5. Results The prevalence of HDAP was 38.4%. Greater severity of illness, experiencing more side effects and poor medication adherence were significantly associated with HDAP.The major predictors of HDAP were antipsychotic polypharmacy and concurrent anticholinergic use. Conclusion We conclude that although the use of HDAP amongst patients with schizophrenia remains common, its persistent use should be discouraged.
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Affiliation(s)
- Ihechiluru G Anozie
- Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria
| | - Bawo O James
- Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria
| | - Joyce O Omoaregba
- Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria
| | - Sunday O Oriji
- Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria
- Department of Mental Health, Nnamdi Azikiwe University, Awka, Nigeria
| | - Paul O Erohubie
- Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria
- Department of Mental Health, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Anthony C Enebe
- Department of Clinical Sciences, Federal Neuropsychiatric Hospital, Benin City, Nigeria
- Department of Mental Health Services, Federal Medical Centre Asaba, Asaba, Nigeria
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Abolmagd S, Aly El-Gabry D, Elkholy H, Abdel Aziz K. Tackling myths of common prescribing patterns in schizophrenia amongst Egyptian psychiatrists. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is limited data related to how psychiatrists actually choose amongst different medications, especially in Egypt. Our aim was to survey a sample of psychiatrists regarding common patterns of antipsychotic prescribing practices and review how these vary from the evidence-based. We conducted a qualitative, cross-sectional survey of 124 psychiatrists of different grades from hospitals across Cairo, Egypt. Questions were asked to elicit attitudes towards common antipsychotic prescribing practices and the use of treatment guidelines in schizophrenia.
Results
A total 77.4% participants said they would prescribe atypical antipsychotics as first-line treatment if cost were not an issue, 42.7% said they commonly add anticholinergics from the start with antipsychotics, 50% said they would maintain patients on anticholinergics for as long as they were receiving antipsychotics, 93.5% said they commonly or in some situations combine typical depot antipsychotics with oral atypical antipsychotics, 88.7% said they commonly or in some situations use antipsychotics in small doses for sedation, and 55.6% sometimes add a mood stabilizer to enhance the effect of antipsychotic drugs. Using logistic regression, physician grade significantly predicted whether participants commonly add anticholinergic medication from the start with antipsychotics (p = 0.001). Age and gender significantly predicted whether participants sometimes add a mood stabilizer to enhance the effect of antipsychotics (p < 0.05).
Conclusions
We demonstrated that several antipsychotic prescribing practices were not evidence-based, yet appeared to be prevalent in a large proportion of participants. A number of demographic and psychiatrist-related factors predicted certain prescribing patterns.
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Marić NP, Andrić Petrović S, Jerotić S, Ristić I, Savić B, Zebić M, Vuković V, Britvić D, Golubović O, Jakšić M, Jevđić K, Kolašinac Z, Lalović N, Mirković Ilić J, Nikolić S, Paunović Č, Pavlović Z, Pejović Nikolić S, Perović V, Popović J, Ranđić Avakumović V, Stojanović S, Tatarević M, Živković I, Voskresenski T, Jovanović N. Maintenance phase treatment of psychotic disorders in outpatients from Serbia - focus on long-term benzodiazepine use. Int J Psychiatry Clin Pract 2020; 24:315-321. [PMID: 32459564 DOI: 10.1080/13651501.2020.1767788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Prescribing trends in maintenance therapy of patients with primary psychotic disorders (PSD) may vary worldwide. Present study aimed to investigate prescription patterns in a sample of outpatients with PSD from Serbia.Methods: In a sample of 73 PSD outpatients we analysed the rate of antipsychotic polypharmacy and psychotropic polypharmacy, concomitant continual benzodiazepine use, and associations between therapy, psychotic symptoms and quality of life.Results: Maintenance therapy (median daily dose 321 mg of chlorpromazine equivalents) predominantly consisted of monotherapy with second generation antipsychotics (45.2%), followed by antipsychotic polypharmacy based on first and second generation combination (25.0%). The median number of psychotropic drugs was 3. Benzodiazepines were continually prescribed to more than 60% of patients (mean daily dose 2.9 ± 2.0 mg lorazepam equivalents). Patients with benzodiazepine use had significantly more psychotropic medications and more antipsychotic polypharmacy, poorer quality of life and more severe psychopathology in comparison to another group.Conclusion: The present study demonstrated new information regarding the prescription patterns of psychotropic drugs in outpatients with PSD in Serbia, amplified with clinically relevant information. This study also revealed distinct prescription patterns concerning antipsychotic/benzodiazepine polypharmacy. Overall, such findings are likely to contribute to improving clinical practice and care for patients with PSD in general.KeypointsPresent exploratory research aimed to elucidate trends of antipsychotics polypharmacy and concomitant use of psychotropic medications including benzodiazepines in the maintenance treatment of outpatients with schizophrenia and other psychotic disorders, amplified with clinically relevant information (symptoms and quality of life).'Antipsychotic (AP) polypharmacy' was defined as concurrent use of more than one AP for at least 1 month; 'Psychotropic polypharmacy' was defined as the combination of AP and a different class of psychotropic drugs medication for at least one month.The median number of prescribed psychotropic drugs was 3 (mean 3.1 ± 1.1) and the average AP daily dose was moderate (median 321 mg of chlorpromazine equivalents). However, the rates of AP polypharmacy (45.2%) and benzodiazepine prescription on a continual basis (>60%) found in our sample could be considered relatively high.Outpatients with higher AP daily dose and higher BPRS symptom score were receiving more benzodiazepines.For improvement of the local, as well as general clinical practice and care for patients with psychotic disorders, and for education in psychiatry, such analyses need to be done on a regular basis and on larger samples.
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Affiliation(s)
- Nađa P Marić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Sanja Andrić Petrović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Stefan Jerotić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivan Ristić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Bojana Savić
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Mirjana Zebić
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Vuk Vuković
- Special Hospital for Psychiatric Diseases "Dr Slavoljub Bakalović", Vršac, Serbia
| | - Dubravka Britvić
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Olivera Golubović
- Special Hospital for Psychiatric Diseases "Dr Slavoljub Bakalović", Vršac, Serbia
| | - Marko Jakšić
- Special Hospital for Psychiatric Diseases "Dr Slavoljub Bakalović", Vršac, Serbia
| | - Katarina Jevđić
- Special Hospital for Psychiatric Diseases "Dr Slavoljub Bakalović", Vršac, Serbia
| | - Zorica Kolašinac
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Nikola Lalović
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Slavica Nikolić
- Special Hospital for Psychiatric Diseases "Dr Slavoljub Bakalović", Vršac, Serbia
| | - Čedica Paunović
- Special Hospital for Psychiatric Diseases "Dr Slavoljub Bakalović", Vršac, Serbia
| | - Zorana Pavlović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Slobodanka Pejović Nikolić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Vukašin Perović
- Special Hospital for Psychiatric Diseases "Dr Slavoljub Bakalović", Vršac, Serbia
| | - Jelena Popović
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Snežana Stojanović
- Special Hospital for Psychiatric Diseases "Dr Slavoljub Bakalović", Vršac, Serbia
| | - Milan Tatarević
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ivana Živković
- Special Hospital for Psychiatric Diseases "Dr Slavoljub Bakalović", Vršac, Serbia
| | - Tatjana Voskresenski
- Special Hospital for Psychiatric Diseases "Dr Slavoljub Bakalović", Vršac, Serbia
| | - Nikolina Jovanović
- Unit for Social and Community Psychiatry - WHO Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London, UK
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Prevalence of Antipsychotic Polypharmacy and Associated Factors among Outpatients with Schizophrenia Attending Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. PSYCHIATRY JOURNAL 2016; 2016:6191074. [PMID: 26904586 PMCID: PMC4745389 DOI: 10.1155/2016/6191074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/26/2015] [Accepted: 12/29/2015] [Indexed: 11/18/2022]
Abstract
Background. Despite recommendations by guidelines to avoid combinations of antipsychotics unless after multiple trials of antipsychotic monotherapy, it is quite a common practice to use combinations. This practice leads to unnecessary expenses and exposes the patient to severe drug adverse effects. Methods. An institution based cross-sectional study was conducted from April to May 2014. Systematic random sampling technique was used to select 423 study subjects. Logistic regression analysis was conducted to identify associated factors of antipsychotic polypharmacy among schizophrenia outpatients. Result. The overall prevalence of antipsychotic polypharmacy was found to be 28.2%. Extra pyramidal side effects (AOR = 2.80; 95% CI: 1.38, 5.71), repeated psychiatric hospitalization (AOR = 2.83; 95% CI: 1.45, 5.50), history of substance use (AOR = 2.82; 95% CI: 1.36, 5.88), longer duration of treatment (AOR = 2.10; 95% CI: 1.14, 3.87), and drug nonadherence (AOR = 1.84; 95% CI: 1.14, 2.98) were found to be significantly associated with antipsychotic polypharmacy. Conclusion. Prevalence of antipsychotic polypharmacy was found to be high among the current study participants. Individuals who had extra pyramidal side effects, admission, substance use, duration of treatment, and drug nonadherence were associated with antipsychotic polypharmacy.
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